Health Information National Trends Survey Research Articles

Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement.

The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6). Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. Clinicians have an important role to ensure that all patients benefit from online EMR use.

The association between YouTube use and knowledge of human papillomavirus-related cancers

ObjectiveTo examine the association between YouTube usage and HPV-related cancer knowledge (cervical, anal, oral and penile). Study designCross-sectional study using data from the Health Information National Trends survey conducted between 2017 and 2020 (N = 16,092). Logistic regression was used to analyze the independent effect of YouTube use on cancer knowledge, controlling for sociodemographic characteristics. ResultsRespondents' knowledge of HPV-related cancers varied: 49.9% about cervical, 18% anal, 20.1% oral and 20.4% penile cancers. YouTube use was associated with increased knowledge for all cancers (cervical: OR 2.66, 95% CI 2.04, 3.46; anal: OR 1.83, 95% CI 1.32, 2.53; oral: OR 1.89, 95% CI 1.37, 2.61; penile OR 2.00, 95% CI 1.44, 2.77) in models adjusted for all covariates. Other independent predictors of HPV-related cancer knowledge included female gender, younger age, a higher income, and higher education. Conclusion(s)YouTube could play an important role in educating people about HPV-related cancers and should also target other populations, such as males and those with less formal education. InnovationThe study provides novel insights into the potential of YouTube as an educational tool for promoting cancer knowledge with the goal of cancer prevention.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study.

Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Cancer survivors with sub-optimal patient-centered communication before and during the early COVID-19 pandemic

ObjectivesPatient-Centered Communication (PCC) is an essential element of patient-centered cancer care. Thus, this study aimed to examine the prevalence of and factors associated with optimal PCC among cancer survivors during COVID-19, which has been less studied. MethodsWe used national survey (Health Information National Trends Survey) among cancer survivors (n = 2579) to calculate the prevalence (%) of optimal PCC in all 6 PCC domains and overall (mean) by time (before COVID-19, 2017–19 vs. COVID-19, 2020). Multivariable logistic regressions were performed to explore the associations of sociodemographic (age, birth gender, race/ethnicity, income, education, usual source of care), and health status (general health, depression/anxiety symptoms, time since diagnosis, cancer type) factors with optimal PCC. ResultsThe prevalence of optimal PCC decreased during COVID-19 overall, with the greatest decrease in managing uncertainty (7.3%). Those with no usual source of care (odd ratios, ORs =1.53–2.29), poor general health (ORs=1.40–1.66), depression/anxiety symptoms (ORs=1.73–2.17) were less likely to have optimal PCC in most domains and overall PCC. ConclusionsWe observed that the decreased prevalence of optimal PCC, and identified those with suboptimal PCC during COVID-19. Practice implicationsMore efforts to raise awareness and improve PCC are suggested, including education and guidelines, given the decreased prevalence during this public health emergency.

The influence of political ideology on clinical trial knowledge, invitation, and participation among adults in the United States.

Clinical trials remain a critical component of medical innovation. Evidence suggests that individuals' political ideologies may impact their health behaviors. However, there is a paucity of literature examining the relationship between political ideologies and clinical trial knowledge and participation. Study data were derived from Health Information National Trends Survey 5 Cycle 4 (n = 3300), which was conducted from February to June 2020. We used participants' characteristics to estimate the prevalence of clinical trial knowledge and participation. We used multivariable logistic regressions to investigate whether political ideology had a significant impact on clinical trial knowledge and participation. Jack-knife replicate weights were applied for population-level estimates. Most participants were White (64.2%), earned above US$50,000 (62.4%), and lived in urban areas (88.0%). About 59.2% reported having some knowledge of clinical trials, and only 8.9% had ever been invited to participate in clinical trials. A total of 37.0%, 29.5%, and 33.5% of the population endorsed moderate, liberal, and conservative political viewpoints respectively. In the adjusted logistic regression analysis, compared to conservatives, liberals (adjusted odds ratio, 1.92; 95% confidence interval, 1.31-2.80) and moderates (adjusted odds ratio, 1.43; 95% confidence interval, 1.09-1.88) had significantly greater odds of having knowledge of clinical trials. Also, liberals had higher odds of receiving invitations to participate in clinical trials (odds ratio, 1.76; 95% confidence interval, 1.08-2.85; p = 0.023) and greater odds of trial participation (odds ratio, 3.90; 95% confidence interval, 1.47-10.33; p = 0.007) compared to moderates. The mechanism underlying the higher rates of clinical trial invitations to liberals is unclear and requires further comprehensive investigation. Similarly, further qualitative studies are needed to understand the attributes that promote knowledge and increased likelihood of clinical trial participation among liberals. This will provide crucial insight to help design interventions that further involve conservatives and moderates in clinical trials and scientific enterprise.

Exploring the Prevalence and Factors Influencing Clinical Trial Awareness in US Adults with Self-Reported Depression and Anxiety.

Lack of clinical trial awareness is a crucial barrier to clinical trial enrollment. The objective of this study was to examine the prevalence and factors associated with clinical trial awareness among US adults with self-reported depression and anxiety. Data were collected from 896 adults who self-reported depression and anxiety from the 2020 Health Information National Trends Survey. Multinomial logistic regression was utilized to assess predictors of clinical trial awareness, particularly socio-demographic, health-related, and technological variables. Odds ratios (OR) for the associations were reported. About 60.4% of adults with self-reported depression or anxiety reported being aware of clinical trials. In the multivariable regression, education level, health-related social media use, and having access to a regular provider were all significantly associated with greater odds of clinical trial awareness among individuals with depression and/or anxiety. Specifically, individuals with at least some college education (OR 2.07, 95% confidence interval (CI); 1.28-3.34; p ​= ​0.004) were more likely to report awareness of clinical trials than those with less than a college education. Similarly, compared to those without access to health providers, individuals with depression and/or anxiety who had a regular provider had greater odds of clinical trial awareness (OR 2.23, 95% CI; 1.16-4.31; p ​= ​0.017). Additionally, those who reported two or more health-related uses of social media were significantly more likely to report clinical trial awareness than their counterparts who reported no health-related social media use (OR 3.17, 95% CI; 1.48-6.80; p ​= ​0.004). Our study shows that about six in 10 adults with depression and anxiety in the United States were aware of clinical trials. However, some sub-groups of patients, particularly those without access to a regular health provider, those with a lower education level, and those with limited use of social media for health purposes, remain inadequately informed and may lack awareness of available clinical trials. These findings are crucial and identify subgroups of people with mental disorders that may benefit from targeted interventions to improve clinical trial awareness.

Using the H2O Automatic Machine Learning Algorithms to Identify Predictors of Web-Based Medical Record Nonuse Among Patients in a Data-Rich Environment: Mixed Methods Study.

With the advent of electronic storage of medical records and the internet, patients can access web-based medical records. This has facilitated doctor-patient communication and built trust between them. However, many patients avoid using web-based medical records despite their greater availability and readability. On the basis of demographic and individual behavioral characteristics, this study explores the predictors of web-based medical record nonuse among patients. Data were collected from the National Cancer Institute 2019 to 2020 Health Information National Trends Survey. First, based on the data-rich environment, the chi-square test (categorical variables) and 2-tailed t tests (continuous variables) were performed on the response variables and the variables in the questionnaire. According to the test results, the variables were initially screened, and those that passed the test were selected for subsequent analysis. Second, participants were excluded from the study if any of the initially screened variables were missing. Third, the data obtained were modeled using 5 machine learning algorithms, namely, logistic regression, automatic generalized linear model, automatic random forest, automatic deep neural network, and automatic gradient boosting machine, to identify and investigate factors affecting web-based medical record nonuse. The aforementioned automatic machine learning algorithms were based on the R interface (R Foundation for Statistical Computing) of the H2O (H2O.ai) scalable machine learning platform. Finally, 5-fold cross-validation was adopted for 80% of the data set, which was used as the training data to determine hyperparameters of 5 algorithms, and 20% of the data set was used as the test data for model comparison. Among the 9072 respondents, 5409 (59.62%) had no experience using web-based medical records. Using the 5 algorithms, 29 variables were identified as crucial predictors of nonuse of web-based medical records. These 29 variables comprised 6 (21%) sociodemographic variables (age, BMI, race, marital status, education, and income) and 23 (79%) variables related to individual lifestyles and behavioral habits (such as electronic and internet use, individuals' health status and their level of health concern, etc). H2O's automatic machine learning methods have a high model accuracy. On the basis of the performance of the validation data set, the optimal model was the automatic random forest with the highest area under the curve in the validation set (88.52%) and the test set (82.87%). When monitoring web-based medical record use trends, research should focus on social factors such as age, education, BMI, and marital status, as well as personal lifestyle and behavioral habits, including smoking, use of electronic devices and the internet, patients' personal health status, and their level of health concern. The use of electronic medical records can be targeted to specific patient groups, allowing more people to benefit from their usefulness.

Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020

Wearable devices may be able to improve cardiovascular health, but the current adoption of these devices could be skewed in ways that could exacerbate disparities. To assess sociodemographic patterns of use of wearable devices among adults with or at risk for cardiovascular disease (CVD) in the US population in 2019 to 2020. This population-based cross-sectional study included a nationally representative sample of the US adults from the Health Information National Trends Survey (HINTS). Data were analyzed from June 1 to November 15, 2022. Self-reported CVD (history of heart attack, angina, or congestive heart failure) and CVD risk factors (≥1 risk factor among hypertension, diabetes, obesity, or cigarette smoking). Self-reported access to wearable devices, frequency of use, and willingness to share health data with clinicians (referred to as health care providers in the survey). Of the overall 9303 HINTS participants representing 247.3 million US adults (mean [SD] age, 48.8 [17.9] years; 51% [95% CI, 49%-53%] women), 933 (10.0%) representing 20.3 million US adults had CVD (mean [SD] age, 62.2 [17.0] years; 43% [95% CI, 37%-49%] women), and 5185 (55.7%) representing 134.9 million US adults were at risk for CVD (mean [SD] age, 51.4 [16.9] years; 43% [95% CI, 37%-49%] women). In nationally weighted assessments, an estimated 3.6 million US adults with CVD (18% [95% CI, 14%-23%]) and 34.5 million at risk for CVD (26% [95% CI, 24%-28%]) used wearable devices compared with an estimated 29% (95% CI, 27%-30%) of the overall US adult population. After accounting for differences in demographic characteristics, cardiovascular risk factor profile, and socioeconomic features, older age (odds ratio [OR], 0.35 [95% CI, 0.26-0.48]), lower educational attainment (OR, 0.35 [95% CI, 0.24-0.52]), and lower household income (OR, 0.42 [95% CI, 0.29-0.60]) were independently associated with lower use of wearable devices in US adults at risk for CVD. Among wearable device users, a smaller proportion of adults with CVD reported using wearable devices every day (38% [95% CI, 26%-50%]) compared with overall (49% [95% CI, 45%-53%]) and at-risk (48% [95% CI, 43%-53%]) populations. Among wearable device users, an estimated 83% (95% CI, 70%-92%) of US adults with CVD and 81% (95% CI, 76%-85%) at risk for CVD favored sharing wearable device data with their clinicians to improve care. Among individuals with or at risk for CVD, fewer than 1 in 4 use wearable devices, with only half of those reporting consistent daily use. As wearable devices emerge as tools that can improve cardiovascular health, the current use patterns could exacerbate disparities unless there are strategies to ensure equitable adoption.

Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use.

We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. Health Information National Trends Survey 2017-2020 data were analyzed. AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.

Association between social media use and health promotion among individuals with depression and anxiety: Insights from the 2017–2020 Health Information National Trends Survey

IntroductionIndividuals with mental disorders have elevated risk factors for cardiovascular disease, and as a result, experience earlier mortality than the general population. Yet, evidence-based strategies and interventions to promote physical and cardiometabolic health in mental health contexts remains limited. Social media has emerged as a promising and readily affordable tool to expand the reach of mental health services, including the delivery of behavioral and physical health interventions. Despite its widespread availability, the potential for social media use to support positive lifestyle behaviors in mental health contexts remains relatively unexplored. We examined the potential for using social media tools for health promotion by people with anxiety or depression. MethodsUsing cross-sectional data from the 2017–2020 edition of the Health Information National Trends Survey (HINTS), we evaluated differences between individuals with self-reported history of diagnosed depression/anxiety and the general population concerning health-related usage of social media platforms. Multivariable logistic regression was performed to evaluate the association between social media usage and positive health behaviors. ResultsOverall, individuals with mental disorders were more likely than the general population to engage in health-related social media usage. Those with anxiety or depression who engaged in health-related social media usage were significantly more likely to; report intentions to quit smoking (OR 3.13, 95% CI 1.12 – 8.70; p = 0.029) endorse past 12-month attempts at smoking cessation (OR 3.41, 95% CI 1.32 –8.82; p = 0.012) and were more likely to meet national recommendation for weekly strength training (OR 1.49, 95% CI 1.11 – 2.00; p = 0.008). ConclusionsPeople with anxiety or depression use social media for health purposes at rates higher than the general population. Our findings suggest that these tools can reach many people with mental disorders and offer a novel window of opportunity to promote physical health and positive lifestyle behavior change in this highly vulnerable population.

Clinical trial knowledge among cancer survivors in the United States: The role of health information technology.

e24039 Background: Clinical trials are essential in the evaluation of new antineoplastic therapies. However, studies have consistently reported suboptimal levels of clinical trial knowledge among adult cancer patients, and less than 5% of them participate in clinical trials. Health information technology (HIT) has shown promise in health promotion and may prove useful in bridging the knowledge gap in clinical trials among cancer survivors. Methods: We obtained data from 3,865 adults who completed the 2020 Health Information National Trends Survey of which 626 (16.2%) were cancer survivors. Using chi-squared tests, we examined the prevalence of HIT use in the general population and by cancer history. We also examined the impact of HIT use on clinical trial knowledge separately for cancer survivors and those with no cancer history using multivariable logistic regression models. Results: 63.8% of cancer survivors reported having some knowledge of clinical trials. Almost half of them used HIT to communicate with doctors (47.1%) and make health appointments (49.4%), about two-fifths (42.2%) used HIT in checking test results and 68.0% reported using HIT to look up health information online. In the adjusted models, the use of HIT in communicating with doctors [OR 2.79; 95% CI (1.41, 5.54)], checking test results [OR 2.47; 95% CI (1.12, 5.43)] and looking up health information online [OR 2.84; 95% CI (1.04, 7.77)] was associated with increased knowledge of clinical trials. Conclusions: Our findings suggest a positive association between HIT utilization and higher clinical trial knowledge levels. These results are encouraging given the rapid increase in mobile technology access globally and the increased use of HIT since the onset of the COVID-19 pandemic. There is a potential opportunity to leverage digital technology in improving clinical trial participation by increasing knowledge levels.

Abstract 4210: Over 10 years since HPV vaccine approval, awareness of the causal link between HPV and HPV-associated cancers remains low in the US

Abstract Background: Over 90% of Human papillomavirus (HPV)-associated cancers could be prevented with the HPV vaccination; yet vaccine uptake remains suboptimal. Awareness that HPV causes several cancers has been shown to improve HPV vaccination uptake. While several efforts to increase HPV-associated diseases awareness as a way to improve vaccine uptake have been made, it is unclear if these efforts have resulted in increased HPV-associated cancers awareness over the years. We examined the awareness of the link between HPV and HPV-associated cancers between 2014 and 2020 in the US. Methods: We used the Health Information National Trends Survey (HINTS) data from 2014 (HINTS 4 cycle 4) to 2020 (HINTS 5 cycle 4). HINTS is a nationally representative survey of adults aged ≥18 in the civilian non-institutionalized US population. HPV-associated cancer awareness was assessed with the question “Do you think HPV can cause i) anal ii) cervical iii) oral and iv) penile cancers”. Responses were “yes”, “no” and “not sure”. Weighted prevalence estimates and corresponding 95% CIs were calculated for all four HPV-associated cancer awareness questions at each timepoint. Results: There were five timepoints included in the study: HINTS 4 cycle 4 (2014, n=2239), HINTS 5 cycle 1 (2017, n=2034), HINTS 5 cycle 2 (2018, n=2050), HINTS 5 cycle 3 (2019, n=2270), and HINTS 5 cycle 4 (2020, n=2340). Awareness of the link between HPV and cervical cancer was high (77.6% in 2014) but decreased by 7.4% between 2014 and 2020 (Table). However, awareness of the link between HPV and anal, oral, and penile cancers was low (around 30% for each cancer type) and remained stable between 2014 and 2020 (Table). Conclusions: Awareness of the link between HPV and HPV-associated cancers has remained steady for anal, oral and penile cancers or declined slightly for cervical cancer over time. There is a need for implementing novel and target interventions to increase awareness and counteract HPV vaccine disinformation. Awareness of the link between HPV and HPV-associated cancers Weighted percent (95% CI) H4C4 (2014) H5C1 (2017) H5C2 (2018) H5C3 (2019) H5C4 (2020) HPV cause anal cancer 27.9 (24.7, 31.1) 29.1 (25.7, 32.5) 24.4 (21.3, 27.5) 28.8 (25.5, 32.0) 27.4 (24.3, 30.6) HPV cause oral cancer 31.2 (28.0, 34.4) 30.7 (27.6, 33.9) 27.0 (23.8, 30.1) 31.1 (27.8, 34.4) 29.5 (26.3, 32.8) HPV cause penile cancer 30.3 (27.1, 33.6) 31.2 (28.1, 34.2) 29.2 (25.9, 32.5) 32.0 (28.7, 35.4) 28.4 (25.1, 31.6) HPV cause cervical cancer 77.6 (74.9, 80.3) 81.5 (78.9, 84.2) 75.0 (72.0, 78.1) 73.9 (70.4, 77.3) 70.2 (67.0, 73.5) Citation Format: Eric Adjei Boakye, Mrudula Nair, Joel Fokom Domgue, Dina K. Abouelella, Heena Y. Khan, Nosayaba Osazuwa-Peters. Over 10 years since HPV vaccine approval, awareness of the causal link between HPV and HPV-associated cancers remains low in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4210.

Association Between the Use of Wearable Devices and Physical Activity Among US Adults With Depression and Anxiety: Evidence From the 2019 and 2020 Health Information National Trends Survey.

Objective The objective of this study was to examine the relationship between wearable device (WD) use and physical activity (PA) levels among US adults with self-reported depression and anxiety. Methods Data were pooled from 2026 adults who self-reported depression and anxiety from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levelsand resistance strength training. Logistic regression was conducted to investigate the association between WD and PA parameters. Results About 33% of adults with self-reported depression/anxiety reported WD use. Only 32.5% and 34.2% of the population reported meeting the weeklyrecommended levels of physical activity (≥150 minutes/week)and strengthand resistance exercise (≥2 timesweekly), respectively. In adjusted analyses, the use of WD was not associated with meeting the national weekly recommendation for physical activity (OR 1.38, 95% CI (0.94, 2.04); p=0.10) or resistance strength training (OR 1.31, 95% CI (0.82, 2.08); p=0.26). Further exploratory analysis also showed that physical activity levels did not differ with the frequency of WD use. Conclusion Despite the popularity of WD use among people with mental disorders, we found that use of WD was not associated with increased physical activity measures, suggesting that although there is a promise for these tools to augment mental health, their real-world effectiveness in promoting physical activity in people with mental disorders remains to be proven.

Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study.

Online Patient-Provider Communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited. Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID vs. pre-COVID. Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 1,900) and adults without a history of cancer (n= 13, 292). COVID included data from February to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (OR) and 95% confidence intervals (95% CI). The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs. 49.7%, email/internet; 32.2% vs. 37.9%, tablet/smartphone; 19.0% vs. 30.0%, EHR). Cancer survivors (OR=1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID. Among cancer survivors, email/internet (OR=1.61, 1.08-2.40) and EHR (OR=1.92, 1.22-3.02) were more likely to be used during COVID than pre-COVID. During COVID, subgroups of cancer survivors, including Hispanics (OR=0.26, 0.09-0.71 vs. non-Hispanic Whites), or those with the lowest income (OR=6.14, 1.99-18.92 $50,000 to <$75,000; OR=0.42, 1.56-11.28 ≥ $75,000 vs. <$20,000), with no usual source of care (OR=6.17, 2.12-17.99), or reporting depression (OR=0.33, 0.14-0.78) were less likely to use email/internet and those who were the oldest (OR=9.33, 2.18-40.01 age 35-49; OR=3.58, 1.20-10.70 age 50-64; OR=3.09, 1.09-8.76 age 65-74 vs. ≥75), unmarried (OR=2.26, 1.06-4.86) or had public/no health insurance (ORs=0.19-0.21 Medicare, Medicaid, or Other, vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR=6.23, 1.66-23.39) or healthcare office visits within a year (ORs=7.55-8.25) were significantly more likely to use EHR to communicate. While not observed in cancer survivors, lower education level was associated with lower OPPC among adults without a history of cancer during COVID. Our findings identified vulnerable subgroups of cancer survivors who were left behind in online patient-provider communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities. Not applicable.

Association of cancer information seeking behavior with cigarette smoking and E-cigarette use among U.S. adults by education attainment level: A multi-year cross-sectional analysis from a nationally representative sample in 2017–2020

Little is known about the association of cancer information seeking behavior with cigarette smoking and e-cigarette use. A multi-year cross-sectional analysis using a pooled data of the Health Information National Trends Survey 5, Cycles 1–4 (2017–2020) was conducted. To examine the association of cancer information seeking behavior with current cigarette smoking (currently smoke every day/some days among individuals who smoked 100+ cigarettes in lifetime) and e-cigarette use (currently use every day/some days among lifetime users) in nationally representative U.S. adults, we conducted weighted multiple logistic regression analysis, adjusting for sex, race/ethnicity, age, obese status, depressed mood, cancer diagnosis history, metropolitan status, and survey year. The regression models were stratified by education level (<college and ≥ college). Individuals in 18–25 years old were excluded as they have not likely completed their education. A final analytic sample included 12,430 adults. Cancer information seekers had lower odds of cigarette smoking than non-seekers, but this was observed in only ≥college group (Adjusted odds ratio [AOR] = 0.78, 95% confidence interval [CI] = 0.61, 0.99). Conversely, cancer information seekers had higher odds of e-cigarette use than non-seekers, but this was significant in only <college group (AOR = 2.12, 95% CI = 1.18, 3.83). Cancer information seeking behavior might help to reduce cigarette smoking when seekers had ≥college education. However, cancer information seeking behavior might positively influence e-cigarette use in <college group. A proper/easy-to-understand dissemination of proven cancer information regarding cigarette smoking and e-cigarette use considering the unproven cancer risk of e-cigarette use is recommended for less educated individuals.

The Effects of Patient-Centered Communication on Emotional Health: Examining the Roles of Self-Efficacy, Information Seeking Frustration, and Social Media Use

The existing literature on the direct association between patient-centered communication (PCC) and emotional well-being often demonstrates inconsistent results. To explain such inconsistency, it is important to explore the mediating and moderating mechanisms underlying this relationship. Built upon the communication pathways model, this study empirically analyzed the Health Information National Trends Survey 5 Cycle 3 dataset (N = 4,709) and tested a moderated mediation model that links PCC to emotional health via information-seeking self-efficacy, with an additional assessment of the moderating effects of information-seeking frustration and social media use. The findings showed that PCC was positively related to emotional health. Also, PCC was indirectly associated with emotional health through information-seeking self-efficacy. In addition, information-seeking frustration and social media use weakened the association between PCC and information-seeking self-efficacy. Furthermore, the indirect path from PCC to emotional health through information-seeking self-efficacy was conditional on both information-seeking frustration and social media use. Important theoretical and practical implications are also discussed.

Examining Disparities in Ownership and Use of Digital Health Technology Between Rural and Urban Adults in the US: An Analysis of the 2019 Health Information National Trends Survey.

Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHTadoption at the national level.Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care. To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey. Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics andsociodemographic factors. The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs.Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797).However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers. We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.

Trust in cancer information and source preference in later life

Objective: To examine the association between older adults’ trust in cancer information and their preference for sources of this type of information. Design: Cross-sectional study. Setting: The USA. Method: The data were obtained from Health Information National Trends Survey 5 Cycle 4 (2020). The sample included older Internet users ( N = 1,223). Results: Higher trust in cancer information from doctors and from religious organisations and leaders, as well as lower trust in cancer information from government health agencies and charitable organisations related to a greater preference for doctors. Greater preference for the Internet was a function of lower trust in cancer information from doctors and higher trust in cancer information from government health agencies. Finally, lower trust in cancer information from doctors and higher trust in cancer information from charitable organisations were associated with greater preference for cancer organisations as a primary source of cancer information. Conclusion: The results imply that doctors represent an source of cancer information, trust in which plays an important role with respect to preference for other sources. The results generally suggest that the trust older adults put in cancer information from different sources appears as a major predictor of their preference for the source of this information.

Examining Disparities in Current E-Cigarette Use among U.S. Adults before and after the WHO Declaration of the COVID-19 Pandemic in March 2020

This paper aims to estimate the prevalence of e-cigarette use before and after the COVID-19 pandemic declaration and to delineate disparities in use across subpopulations. Data were derived from the 2020 Health Information National Trends Survey (N = 3865) to conduct weighted multivariable logistic regression and marginal analyses. The overall prevalence of current e-cigarette use increased from 4.79% to 8.63% after the COVID-19 pandemic declaration. Furthermore, non-Hispanic Black people and Hispanic people had lower odds of current e-cigarette use than non-Hispanic White people, but no significant differences were observed between groups before the pandemic. Compared to heterosexual participants, sexual minority (SM) participants had higher odds of current e-cigarette use after the declaration, with insignificant differences before. People who had cardiovascular disease conditions, relative to those without, had higher odds of current e-cigarette use after the declaration, but no group differences were found before the declaration. The marginal analyses showed that before and after the pandemic declaration, SM individuals had a significantly higher probability of using e-cigarettes compared to heterosexual individuals. These findings suggest the importance of adopting a subpopulation approach to understand and develop initiatives to address substance use, such as e-cigarettes, during pandemics and other public health emergencies.

Palliative Care Knowledge and Attitudes among Patients with Neurodemyelinating Diseases (P8-6.005)

<h3>Objective:</h3> Evaluate PC knowledge and attitudes of patients with neurodemyelinating diseases. <h3>Background:</h3> Neurodemyelinating diseases lead to functional loss, requiring demanding care with great distress to patients and their caregivers. Palliative care (PC) would benefit these individuals. However, PC inpatient neuro services have only increased from 0.2% to 6% (2005–2014, respectively) without increases in ambulatory settings. <h3>Design/Methods:</h3> A cross-sectional, descriptive design with a convenience sample of 84 patients from 3 neuroimmunology clinics in a Northeastern healthsystem was performed. Participants completed a confidential survey composed of PC Knowledge Scale (PaCKS) and PC Health Information National Trends Survey (HINTS). Murray’s transition theory guided this study, which contextualizes the chronic condition integrating PC services, patient decision-making, communication, and care coordination. Descriptive statistics characterized the sample and the survey responses. <h3>Results:</h3> Most participants were white race (79%), non-Hispanic ethnicity (77%), female gender (69%) and 57% had formal higher education. 82% had multiple sclerosis (MS). A small proportion had advance directives (21%). Approximately 48% to 62% correctly answered PaCKS knowledge questions about PC eligibility criteria (3-items), goals (7-items), and operations (3-items). HINTS focused on PC attitudes and 42% indicating that they never heard of PC. Of the remaining participants, 77% to 87% agreed/strongly agreed with 3-items reflecting PC goal (coping, support, symptom management), whereas, 30% disagreed/strongly disagreed that PC gave patients more time at end-of-life. More than 50% accurately disagreed/strongly disagreed with 4-items that were more aligned with hospice care not PC. Most (67%) felt doctor’s had an obligation to inform patients about PC. <h3>Conclusions:</h3> Many participants were unaware of PC, had knowledge gaps, or inaccurate attitudes about its services and benefits. Results provide a call-to-action for nurses and providers to counsel patients and refer them to PC. Interventional studies are needed to test strategies to improve PC access and related outcomes. <b>Disclosure:</b> Ms. Ben-Zacharia has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Ms. Ben-Zacharia has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Ms. Ben-Zacharia has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Greenwich Biosciences. Ms. Ben-Zacharia has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Theraputics. The institution of Ms. Ben-Zacharia has received research support from Biogen. The institution of Ms. Ben-Zacharia has received research support from Greenwich Biosciences. Ms. Bartels has nothing to disclose. Helen Brugger has nothing to disclose. Jena Malchiodi has nothing to disclose. Mrs. Carbone has nothing to disclose. Dr. Volandes has nothing to disclose. Francois Bethoux, MD has nothing to disclose.